Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0134000266 | VA |
N | 106S00000X | Behavior Technician |
NPI | 1154898278 |
---|---|
Provider Name | Kristen Grilli |
First Address | Chesapeake, VA 23322-6619 |
Second Address | Chesapeake, VA 23322-6619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2018 |
Last Update Date | 23/01/2021 |